Audit of the Commonwealth Health Insurance Connector Authority (December 23, 2024)

This is a state performance audit of the Massachusetts Health Connector, the public marketplace that helps residents and small businesses find health insurance.

“According to its website, the Connector’s mission is to “advance access to high-quality health care by serving as a transparent and transformative marketplace for Massachusetts residents and small businesses to come together and easily find, compare, and enroll in affordable health insurance.””

Auditors checked whether the Connector properly tested applicants’ eligibility, handled complaints, documented complaint resolutions, and trained employees on cybersecurity.

“The purpose of our audit was to determine whether the Connector did the following:”

If possible fraud complaints are not logged, the agency cannot show how many complaints came in, how serious they were, or whether they were handled properly.

“Without documentation of fraud complaints received, the Connector cannot monitor the number of complaints, as well as actions taken to address specific complaints.”

If you use or contact the Health Connector, better complaint tracking can make it easier for the agency to follow up, spot problems, and prove that concerns were handled.

“Anyone can request assistance from the Connector by telephone, email, or mail or in person.”

The Connector passed the audit’s eligibility-check and cybersecurity-training reviews, but failed the complaint documentation review.

“Did the Connector have policies and procedures to process complaints, and did it document the actions taken to resolve the complaints it received?”

The auditor recommended that the Connector create written complaint procedures and log fraud complaints with records showing how they were resolved.

“The Connector should develop and implement written policies and procedures surrounding the receipt and resolution of complaints.”

This matters because the lack of a complaint log leaves both managers and auditors without the records they need to evaluate whether the Connector is handling complaints well.

“This prevents Connector management from receiving relevant information to assist in the management and improvement of the operations of the authority and prevents auditors from receiving documentation to support audits that review the performance of the Connector.”

An “assister” means a trained enrollment helper who can explain coverage choices and help people find affordable insurance.

“An assister is a certified enrollment expert who can help applicants understand their coverage options, answer questions they may have, and help them find the most affordable coverage that meets their needs.”